Between crossfire…: graduate degree level, policy on higher education and training in health promotion

Abstract

Over the past 20 years, there has been a significant transformation within Latin American subcontinent in the organizational culture of public universities, as well as a change in the status, identity and practices of the academic profession. Higher education institutions are faced with the need to complement government funding with external funds including, but not limited to, the industrial sector. These institutions are also faced with requirements to become publicly accountable for their performance and results. This situation has led some authors (1) to claim that higher education has gone from being a public asset to an economics-centered model in which many institutions are evaluated by their ability to secure funding and not actually to provide the system with feedback. In Latin America and in some universities in Spain (2) the process of accountability has been linked with a growing tension placed on these institutions, dominated by conflicts between groups and individuals, both in terms of the struggle to successfully obtain financial subsidies and of meeting external demands to certify the academic quality of the teaching staff and the teaching programs. Since the early 1990s, several economic incentive programs linked with attaining indicators (as defined by externally developed standards) have been designed, thus creating a highly fragmented evaluation system, with very diverse criteria and characteristics. Within this highly complex context, a small number of health promotion (HP) graduate programs have emerged in some higher education institutions in Central and South America. With regards to health education (HE), in a scientific study published in the late 1980s, Maria Antonia Modolo (3) stressed the co-existence of two HE staff training models. The first (particularly common in some English-speaking countries) aimed to train specific personnel in this field at graduate level. Therefore, a number of high school diplomas and graduate degrees in HE exist in the educational institutions of these countries. The second training model adopted the principle that HE responsibilities should be shared by all members of the health team, and that they represent just another component (such as basic science, clinical science and epidemiology) of the curriculum of future professionals. It is this latter model that has guided (whether deliberately or not) education in both HE and HP in most Latin American countries. One student who was nearing the end of an HP graduate program complained: